Provider Demographics
NPI:1477842557
Name:CLAYTON THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:CLAYTON THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:EDS , LMFT
Authorized Official - Phone:706-782-6827
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:RABUN GAP
Mailing Address - State:GA
Mailing Address - Zip Code:30568-0647
Mailing Address - Country:US
Mailing Address - Phone:706-782-6827
Mailing Address - Fax:706-782-0124
Practice Address - Street 1:24 CHECHERO ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525
Practice Address - Country:US
Practice Address - Phone:706-782-6827
Practice Address - Fax:706-782-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALMFT000668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty